Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $21.21 / $97.07 / $249.79	Facility		$21.21	$97.07	$249.79
Aetna Facility/Professional Facility Modifier CO Low / Median / High Price $63.65 / $101.52 / $636.95	Facility	CO	$63.65	$101.52	$636.95
Aetna Facility/Professional Facility Modifier CQ Low / Median / High Price $72.48 / $169.44 / $173.88	Facility	CQ	$72.48	$169.44	$173.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.95 / $22.75 / $52.73	Professional		$14.95	$22.75	$52.73
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $26.85 / $26.85 / $46.88	Professional	CQ	$26.85	$26.85	$46.88
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $28.00 / $31.00 / $46.36	Facility		$28.00	$31.00	$46.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.39 / $22.07 / $39.60	Professional		$17.39	$22.07	$39.60
Aultcare Facility/Professional Facility Modifier Low / Median / High Price $21.36 / $21.36 / $39.36	Facility		$21.36	$21.36	$39.36
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $24.41 / $24.41 / $39.97	Professional		$24.41	$24.41	$39.97
CareSource Facility/Professional Facility Modifier Low / Median / High Price $30.51 / $33.56 / $45.31	Facility		$30.51	$33.56	$45.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $30.51 / $36.61 / $69.00	Professional		$30.51	$36.61	$69.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $39.13 / $65.00 / $140.00	Facility		$39.13	$65.00	$140.00
Cigna Facility/Professional Facility Modifier CO Low / Median / High Price $31.05 / $31.05 / $31.05	Facility	CO	$31.05	$31.05	$31.05
Cigna Facility/Professional Facility Modifier CQ Low / Median / High Price $31.05 / $31.05 / $31.05	Facility	CQ	$31.05	$31.05	$31.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.81 / $47.13 / $111.17	Professional		$26.81	$47.13	$111.17
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $40.88 / $73.91 / $128.31	Facility		$40.88	$73.91	$128.31
Medical Mutual of Ohio Facility/Professional Facility Modifier CO Low / Median / High Price $31.05 / $31.05 / $31.05	Facility	CO	$31.05	$31.05	$31.05
Medical Mutual of Ohio Facility/Professional Facility Modifier CQ Low / Median / High Price $31.05 / $31.05 / $31.05	Facility	CQ	$31.05	$31.05	$31.05
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $25.55 / $38.13 / $57.97	Professional		$25.55	$38.13	$57.97
Medical Mutual of Ohio Facility/Professional Professional Modifier CQ Low / Median / High Price $26.22 / $31.30 / $34.50	Professional	CQ	$26.22	$31.30	$34.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $24.11 / $32.77 / $48.62	Professional		$24.11	$32.77	$48.62
United Facility/Professional Professional Modifier Low / Median / High Price $22.31 / $29.76 / $41.97	Professional		$22.31	$29.76	$41.97